Thursday, April 27, 2017: Health and the Local Elections – a strange silence

Scotland’s councils now have a pivotal role in deciding how the £8 billion integrated health and social care budget should be spent – but you wouldn’t think that when looking at the Local Election manifestos.

It’s not long since, in 2009, the Scottish Government was championing a plan to elect members of Scotland’s NHS Boards in what the then Health Secretary, Nicola Sturgeon, said was a “massively popular” move to increase accountability. The plan was abandoned in 2013 when pilot elections in Fife and Dumfries and Galloway saw a low turnout of voters.

Last year the 31 integration authorities – the health and social care partnerships that effectively mirror Scotland’s council areas – came into being, with half of the voting member seats on their Integrated Joint Boards (IJBs) being allocated to local councillors.

So, in terms of the delivery of primary and community health services and local social care services, elected councillors have equal status in deciding what happens as the members of the IJB who have been appointed by the area’s NHS Board. It’s a key appointment for a councillor and arguably, alongside education, one of the most important areas of any council’s work for citizens. And even if a councillor is not asked to serve on an IJB, he or she still has a role in setting the budget for the council’s contribution to the IJB’s work.

At a national level, for all the Scottish political parties, whether they are judged competent to run the NHS and deliver social care has a massive impact on their success at the ballot box.

It is intriguing, then, that little space is given by the five main Scottish political parties to health and social care partnerships in their local election manifestos – in some cases they are not mentioned at all by name – despite the role councillors elected on 4 May will have in local health and care policy.

Scottish Labour talks about its record “working closely with local health boards to integrate NHS care with their own social care services”, but its other mentions of health are mainly around how spending on it has been cut by the Scottish Government.

The SNP says: “SNP Councils will use funding from the Scottish Government to invest in social care, making sure that people receive the care they need in the best place for them, be it in their homes or a homely setting.

All the parties talk about the delivery of their policies for people with mental ill health. Indeed, for the Scottish Liberal Democrats, mental health support is presented as a priority with lots of detail on what the party would do locally. They do not mention of services for physical ill health.

The Scottish Conservatives say it’s too early to judge the effectiveness of the health and social care partnerships, but warn they cannot continue to be underfunded. Their manifesto says: “Although there is cross-party support for closer integration, there are some concerns over the loss of democratic accountability and an increase in centralisation since they were formed”.

The Scottish Greens meanwhile say that their councillors will: “support and enable locally led social care partnerships and social enterprises to provide good-quality care at home” and “ensure that the development and delivery of health and social care integration and provisioning of services is fully informed by the views and suggestions of disabled people who use those services”.

The question is whether it matters that two out of five main political parties don’t mention the health and social partnerships as such.

These manifestos are put out by the party headquarters for the whole of Scotland. Often they are supplemented by local documents focusing on local issues. Perhaps more space in devoted to the IJBs and the partnerships in these (though not where I live).

You could argue that you don’t need to bother voters with the detail of the decision mechanism for local health spending so long as you talk about what the money will be spent on.

However, if you value the role of elected as opposed to appointed decisionmakers its seems odd not to be more explicit about the role of councillors on the IJBs.

Is there perhaps a concern that, if councillors are given too clear a mandate for their work in local health and care, they might feel they have a greater mandate and a louder voice when they talk about their funding difficulties? Perhaps there is a feeling that most voters have difficulty enough distinguishing between what the NHS does and what councils do without talking about what they do together.

Maybe after the new councils are formed they should make it a priority to explain the work of the health and social care partnerships and the important role that councillors play in setting their direction.

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Ettrickburn supports the communication and engagement needs of organisations involved in healthcare and science in Scotland.